The severity of coronary artery atherosclerosis correlates with increased plasma concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides and with decreased plasma concentrations of high-density lipoprotein cholesterol (HDL-C). The role of plasma lipoproteins in the pathogenesis of cerebral atherosclerosis, however, is less clear. Several investigators report that lipoprotein abnormalities correlate inversely with the incidence of cerebral infarction. We analyzed risk factors for carotid bifurcation atherosclerosis in 121 consecutive patients who underwent cerebral angiography. This analysis revealed a significant positive correlation between the plasma TC/HDL-C ratio and the extent of carotid bifurcation atherosclerosis (p = 0.01). The extent of atherosclerosis correlated inversely with plasma concentrations of HDL-C (p = 0.02). Triglyceride concentration correlated positively with the extent of atherosclerosis with marginal significance (p = 0.07). LDL-C and TC concentrations did not correlate with bifurcation atherosclerosis (p greater than 0.1). Only 4% of the variation in the extent of bifurcation atherosclerosis was explicable on the basis of plasma lipoprotein concentrations.